Childhood obesity has almost tripled in the last two decades and is considered one of the most serious health problems facing youth, with minority and low-income children at disproportionately higher risk. Although previous research has provided a good understanding of individual level risk factors (e.g. food choices) that contribute to childhood obesity, the connection between the home food environment and interpersonal interactions (e.g. support, communication, conflict) that exist in the home environment related to eating behaviors and childhood obesity has been largely overlooked. The primary objective of this application is to identify how the home food environment and the interpersonal interactions among family members related to eating behaviors create risk or protective factors for childhood obesity. The proposed two year cross-sectional study, stratified by weight status (e.g. normal weight vs. overweight/obese), uses an innovative mixed methods approach to collect direct observational data (video-recorded family meals, home food inventory), qualitative data (interviews with caregivers), and quantitative data (BMI, dietary intake) in order to provide an in depth description of the home food environment and examine associations with child weight status and dietary intake. Sixty overweight/obese children (e85th BMI %tile for age and gender) and 60 normal weight children (>5th %tile BMI <85th for age and gender), ages 6-12, will be recruited from primary care clinics to participate in an in-home observation study with their families. The one week in-home observation will include: (a) video- recordings of family meals for eight consecutive days via a laptop computer, (b) an observational assessment of the home food environment, (c) an in-depth qualitative interview with caregivers (at least one caregiver, and two when available), (d) anthropometric measures of target child, two caregivers (when available) and closest aged sibling (when available), and (e) three 24-hour dietary recalls on the target child conducted with the primary caregiver. The in-home observations will acquire family level, dyadic level and individual level data. By triangulating these data sources, a comprehensive and in-depth look at the home food environment will be possible and complex family dynamics will be able to be assessed. The novel risk and protective factors identified in this study will be used to develop an R01 family-based intervention study with ethnically/racially diverse children ages 6-12, who are at greatest risk for overweight and obesity. The results from the proposed study are expected to identify critical new targets for interventions that can be implemented in partnership with primary care clinics and other health care settings with families to prevent childhood overweight and obesity. The interdisciplinary research team brings expertise from family social science, child and adolescent nutrition, obesity prevention, family medicine, epidemiology and biostatistics. Findings from the proposed study will move the field forward in conceptualizing the home food environment more comprehensively, in order to create research-informed interventions that are more effective in preventing childhood obesity. PUBLIC HEALTH RELEVANCE: This innovative study uses in-home observations (video-recorded family meals, home food inventory, interviews) of the home food environment to obtain a more comprehensive understanding of the risk and protective factors for childhood obesity in the home environment. The results are expected to directly inform the creation of interventions to prevent childhood obesity.